HomeMy WebLinkAboutNCC191957_NOI Application_20190920Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/18/2019 2:09:29 PM (NCG01 NOI Submission)
Approve by Clark, Paul 9/18/2019 3:29:33 PM (Review- Construction NOI 16051)
• The task was assigned to Clark, Paul by round robin distribution 9/18/2019 2:10 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 20, 2019 5:00
PM 9/18/2019 2:10 PM
Submit by McCoy, Suzanne 9/20/2019 9:50:25 AM (Payment Verification for NCC191957)
* Karla Garns.
• McCoy, Suzanne assigned the task to McCoy, Suzanne 9/20/2019 9:49 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 30, 2019 5:00 PM
9/18/2019 3:29 PM
117-8) sT.:2,G) M F1Ii f_TiI a 10141
NORTH CAROLINA
Ernvlronmentol qualily
A. Project Information
Part A.
Project Location and Waterbody Inforrration
1. Project Name * Northern Regional RecreationCenter(NRRC)
2. County* Mecklenburg
3. Highway or Street 18121 Old Statesville Road
Address * Street name only is acceptable if no address nurrtrer assigned yet
4. City or Township* Cornelius
5. State * NC
6. Zip Code* 28031
7. Latitude * Enter the latitude in decirral degrees
35.4580
8. Longitude * Enter the longitude in decirral degrees (WISTbe negative)
-80.8500
If you do not know the latitude and longitude coordinates for this project, you can search the location on this map of
North Carolina. Look for the coordinates in the bottom left corner.
9. Date to Begin * 01 /20/2020
Estimated Construction Project Start Date
10. Date to End* 07/26/2021
Estimated Construction Project End Date
11. SIC (Primary)* Commercial (1542)
Standard Industrial aassification for Development
12. Acres to be 22.90
disturbed* (including off -site borrow and waste areas)
13. Total site area
45.69
(acres)*
14. Post-
6.58
construction
(Estimated)
impervious area
(acres) *
NCC Project
NCC-MECKL-2020-Northern Regional RecreationCenter(NRRC)
Tracking ID
Assigned autorratically
Below you must enter waterbody information for surface waters affected by this project. Please consult
DWR's Surface Water Classifications Map Viewer to find waterbody name and corresponding index number. Please
enter only immediate receiving waterbodies - not waters downstream of those unless the project extends there. You
may enter up to 3 waterbodies if needed.
15a. Receiving Caldwell Station Creek
Wate rbody* Nanre of waterbody into which stormuater runoff will discharge
15b. Waterbody 11-115-2-(1)
Index No.* NC Waterbody Index Narrber
Stormwater W No
discharges will flow F Yes
to additional
wate rs *
16a. Is this project F Yes
subject to the NC r No, not subject to NC SPCA
Sediment Pollution
Control Act?*
B. Permittee Information
Part B.
Perrrittee Information - Legally Responsible Entity and Individual
.....................................................................................................................................................................
h
Important: The person who signs the NOI Certification Form and signs the Certification in Section E of this application
form should be the same person as listed in THIS SECTION, or an authorized responsible individual within the same
organization. That person must be a responsible corporate officer who owns or operates the construction activity, such
as a president, secretary, treasurer, or vice president, or a manager that is authorized in accordance with Part IV,
Section B, Item (6) of the NCG010000 General Permit. For more information on signatory requirements, see Part
IV, Section B, Item (6) of that permit.
1. Organization Mecklenburg County
Name *
2. First Name* Leslie
ff Corporation, enter Registered Agent First l\b e
3. Last Name * Johnson
ff Corporation, enter Registered Agent Last Barre
3b. Title Assistant County Manager
4. Permitee E-mail leslie.johnson@mecklenburgcountync.gov
Address*
5. Permittee 980-314-2910
Telephone No.*
6. Permittee Mailing Street Address
Address* 3205 Freedom Drive
Address Line 2
Suite 6000-Peter Wasmer-AFM
City
Charlotte
Pastal / Zip Code
28208
Check box if the
street address the
same as mailing
address
7. Permittee Street
Address*
r Yes
Street Address
600 E. Fourth Street
Address Line 2
11th Floor- Leslie Johnson
City
Charlotte
Pastal / Zip Code
28202
State / Province / Region
NC
Country
US
State / Province / Region
NC
Country
USA
C. Site Contact Information
Part C.
Roiect Site Contact Information
1. Type of
Ownership*
2. Primary Site
Contact - First
Name *
3. Primary Site
Contact - Last
Name *
4. Title
5. Site Contact E-
mail Address*
6. Site Contact
Telephone No.*
7. Organization
Name
8. Site Contact
Mailing Address*
9. Consultant Name
10. Consultant E-
mail
11. Consultant
Telephone No.
Government - County
Peter
Wasmer
Project Manager-AFM
peter.wasmer@mecklenburgcountync.gov
704-564-5563
Asset and Facility Management -Mecklenburg
County
Street Address
3205 Freedom Drive
Address Line 2
Suite 6000
city
Charlotte
R>stal / Zip Code
28208
(Optional)
David Starkel
First and Last narre
dstarkel@stevmrtinc.com
This person will be copied on all correspondence.
704-909-3513
State / Province / Plegion
NC
Country
us
D. E&SC Plan
Part D.
Erosion & Sediment Control (E&SC) Ran Approval Information
.......................................................................................................................................................................................................................................
1. Date E&SC Plan 08/26/2019
Approved *
2. E&SC Plan Project MECKL-2020-012
Number/ID* Assigned by agency or local program
3. E&SC Plan f• State DEQ Office
Approved by r Local Program
4. State DEQ Office * Mooresville (MRO)
Documentation of E&SC Plan approval and the signed Notice of Intent (NOI) Certification Form is required for a
complete application.
5. E&SC Plan jm+-08262019.pdf 1.48MB
Approval Mist be FCFforrrat
letter/documentation
6. NOI Certification NCGO1 NOI Certifcation Form - Northern Regional
Form 527.83KB
Rec_.pdf
IvUst be RCF format
This is an Express f• No
Review Project* r Yes
E. Certification
North Carolina General Statute 143-215.613 (1) provides that:
Anyperson who knowinglymakes any false statement, representation, or certification in anyapplication, record, report, plan, or other
documentfiled or required to be maintained under this Article or a rule implementing this Article; or who knowinglymakes a false statement
of a material fact in a rulemaking proceeding or contested case under this Article; or who falsifies, tampers with, or knowingly renders
inaccurate any recording or monitoring deice or method required to be operated or maintained under this Article or rules of the
Commission implementing this Article shall be guiltyofa Class 2 misdemeanor which mayinclude a fine not to exceed ten thousand
dollars ($10,000).
Under penalty of law, I certify that:
rJ I am the person responsible for the construction activities of this project, for
satisfying the requirements of this permit, and for any civil or criminal penalties
incurred due to violations of this permit.
* rJ The information submitted in this NOI is, to the best of my knowledge and belief,
true, accurate, and complete based on my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information.
* I7 I will abide by all conditions of the NCG010000 General Permit and the
approved Erosion and Sediment Control Plan.
* rJ I hereby request coverage under the NCG010000 General Permit and
understand that coverage under this permit will constitute the permit
requirements for the discharge(s) and is enforceable in the same manner as an
individual permit.
Specify if you are:* r The Responsible Person named on this Notice of Intent
r Authorized Responsible Person*
Important: The person who electronically signs this Certification above must be the same person who signs the NOI
Certification Form. If that person is signing on behalf of the Permittee, that individual must be an authorized responsible
person within the same organization as the Permittee. *An authorized individual is a responsible corporate officer who
owns or operates the construction activity, such as a president, secretary, treasurer, or vice president, or a manager
that is authorized in accordance with Part IV, Section B, Item (6) of the NCG010000 General Permit. For more
information on signatory requirements, see Part IV, Section B, Item (6) of that permit.
Signature
Type Name * Leslie Johnson
Title Assistant County Manager
Organization Mecklenburg County
Date * 09/18/2019
F. Tracking and COC Info
NOI Tracking No. 16051
NC Reference No. NCG01-2019-1957
Uses 'count number variable (incremented by SP)
Certificate of NCC191957
Coverage (COC) Uses 'count _nunber'variable (increrrented bySP)
No. *
Count Number 1957
Sequential nunber for subrrittal that is incremented by Stored Procedure
COC Year 2019
Year of date reviewed (used to assign YY digits after "NGC' in OOCno.)